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Health care expansion through ACA may have reduced incidence of cardiac arrest
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The rate of cardiac arrests decreased in patients who acquired health insurance due to the Affordable Care Act, according to a study published in the Journal of the American Heart Association.
“Cardiac arrest is devastating and under-recognized cause of premature death for both men and women older than 45 years,” Eric Stecker, MD, MPH, associate professor of cardiology at Knight Cardiovascular Institute at Oregon Health and Science University in Portland, said in a press release. “Health insurance allows people to engage in regular medical care, which is crucial for the prevention of [CVD] and the diagnosis and treatment of conditions that can cause cardiac arrest.”
Cardiac arrests in adults
Researchers analyzed data from EMS dispatches for cardiac arrest for residents of Multnomah County, Oregon, which had 636,000 adults in 2015. Cardiac arrest data were compared between the 2 years before health care expansion (2011-2012) and the 2 years after it (2014-2015) in middle-aged (aged 45-64 years) and elderly (aged at least 65 years) populations.
The incidence of out-of-hospital cardiac arrest in the middle-aged population decreased from before expansion (102 cases per 100,000 patients; 95% CI, 92-113) to after expansion (85 cases per 100,000 patients; 95% CI, 76-94). The rate of cardiac arrest did not significantly change in the elderly population from before expansion (275 cases per 100,000 patients; 95% CI, 250-300) to after expansion (269 cases per 100,000 patients; 95% CI, 245-292).
The incidence of out-of-hospital cardiac arrest decreased in the middle-age population by 17% (95% CI, 3.7-31) after the health care expansion. The rate did not substantially change in the elderly population.
Outcomes of health care expansion
“Given evidence showing that individuals who receive health insurance engage more effectively in [CV] care, it is plausible to consider that improved diagnosis and prevention of [CVD] resulting from expanded insurance availability could explain the observed decrease in [out-of-hospital cardiac arrest] incidence among middle-aged Multnomah County residents,” Stecker and colleagues wrote.
A limitation of the study “is that the determination of primary cardiac etiology for any [out-of-hospital cardiac arrest] was made on the basis of EMS information gathered at the time of arrest,” Mary Fran Hazinski, RN, MSN, FAAN, FAHA, professor in the division of trauma and surgical critical care at Vanderbilt University School of Nursing in Nashville, Tennessee, and Carole R. Myers, PhD, RN, associate professor in the department of public health at the University of Tennessee College of Nursing in Knoxville, wrote in a related editorial. “As a result, the study may have over- or underestimated [out-of-hospital cardiac arrest] magnitude. The study was performed at a time that Oregon was simultaneously experiencing what the authors note was an ‘extensive health care payment and delivery innovation.’ This included establishment of Patient-Centered Primary Care Homes, with an integrated system of regional coordinated care organizations that were required to follow evidence-based guidelines and monitor quality of care as well as cost-effectiveness. Thus, the findings of Stecker and colleagues may not be generalizable to other states or even to other counties in Oregon.” – by Darlene Dobkowski
Disclosures: The researchers and Myers report no relevant financial disclosures. Hazinski reports receiving compensation as a senior science editor for resuscitation science statements when she was a consultant to the AHA’s emergency CV care programs.
Perspective
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John Warner, MD
The findings are provocative. It’s an interesting finding in that it showed a decrease in the number of out-of-hospital cardiac arrests in patients in a Medicaid expansion state, but we really don’t know enough yet about why that decrease occurred. It was only present in younger patients, which would typically be the ones that would have received expansion coverage.
The study was really underpowered to determine definitively whether or not the insurance status was the cause of the decline in the out-of-hospital cardiac arrests. We’ll need to know more about the patient’s risk and their access to and utilization of preventive services to understand why this potential decline occurred.
We know that access to preventive services improves care, particularly in patients with cardiac disease, so seeing more research into prevention and its impact on mortality, particularly in high-risk CV populations, is an area of intense research interest.
Any successful legislation will need to improve access to care and also improve access to preventive services in order to improve the CV health of a broad population. Regardless of whether it’s this version of the bill or any subsequent version of the bill, improving access to care and improving the access to preventive services for CVD will be critically important.
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